Autism evaluations · Toddlers, children and teens

Comprehensive autism diagnostic evaluations (ADOS-2) for toddlers, children and teens in Maryland

When your pediatrician, your child’s school or your own instincts raise questions about development, an evaluation can bring clearer answers. Ask whether an assessment with a PsyD clinician, where the ADOS-2 may be one part, fits your child.

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Key takeaways

A comprehensive autism evaluation looks at your child from more than one angle. Here is what to expect and what to ask.

Why earlier answers can help

If your pediatrician just flagged developmental concerns, take a breath. It’s natural to want answers quickly, and waits for autism evaluations can be long. It helps to know what you can start while you wait.

The American Academy of Pediatrics recommends developmental surveillance at every well-child visit and autism screening at 18 and 24 months, so your pediatrician’s flag is part of a process designed to notice differences early. Early signs can include differences in joint attention, such as not pointing to share interest or not looking where another person points.

You don’t need a diagnosis to get support started. For children under age 3, Maryland’s Infants and Toddlers Program offers evaluation and early intervention at no cost, with no diagnosis or doctor’s referral needed. For children 3 and older, you can request a free Child Find evaluation through your local public school system.

Early intervention, diagnostic evaluations and school-based support are separate parts of a broader system. Pediatricians and other professionals can send referrals through our referrals page.

What happens during your child’s ADOS-2 evaluation?

An ADOS-2 session looks much more like play than a typical medical exam. Through toys, bubbles, snacks, pretend play or conversation, the clinician observes how your child communicates, shares attention, takes turns and plays. As a standardized assessment, the ADOS-2 looks at communication, social interaction, play, and restricted or repetitive behaviors, compared with what is expected for your child’s age.

A comprehensive evaluation usually brings several pieces together:

A screening tool such as the M-CHAT-R/F can help families understand whether further evaluation may be appropriate, but a screening score does not diagnose autism. Ask intake which steps apply to your child and how appointments are arranged. Families of children ages 2–6 can read more about M-CHAT-R screening and ADOS-2 evaluation for toddlers. For more on early signs and screening, read our autism and early intervention guide.

Step 1: ADI-R parent interview and developmental history

A comprehensive evaluation often starts with you. The ADI-R is a standardized, semi-structured interview with a trained clinician, usually without your child in the room. It covers three domains: communication, reciprocal social interaction, and restricted and repetitive behaviors.

What the interview covers

The full ADI-R is a long conversation, so ask intake how much time to plan and whether to arrange childcare. Ratings are based on your real examples rather than simple yes-or-no answers.

Nothing you share is judged. Your memories give clinicians developmental context that direct observation alone can’t provide, and the caregiver interview is paired with direct observation because no single measure tells the whole story.

Preparing for the parent interview

A caregiver who knows your child’s early history well is usually the right person to join. Plan for a quiet, uninterrupted stretch of time, and gather anything that helps you remember:

Share real examples, and say so when you’re not sure. “I don’t remember” is a useful answer, and it’s more helpful than a guess.

Autism and ADHD can co-occur, and other developmental questions may overlap. A comprehensive evaluation may consider attention, language and other concerns alongside autism. An evaluation is also about understanding your child’s strengths and needs, not only identifying differences.

Step 2: Play-based ADOS-2 modules for every age

The play materials look similar from child to child. What changes is the module, the set of activities and conversational demands chosen for your child. Module choice depends mainly on your child’s spoken language, with age also considered for some modules.

Age points to a starting place, but your child’s everyday spontaneous speech guides the final choice. The clinician looks at the language your child uses on their own most of the time, not a single phrase or repeated words. When the fit is unclear, a module with fewer language demands is often chosen so the activities match your child. Your child completes only one module.

For the youngest children, the Toddler Module describes a range of concern rather than a classification. That helps the clinician decide whether monitoring or further assessment makes sense.

Bubbles, blocks and motivating toys invite requesting, sharing attention and turn-taking. Snacks create chances to comment or respond, and pretend scenarios can show imaginative play. The clinician also notes how your child responds to their name, starts interactions and uses gestures such as pointing or showing. The session typically lasts about 40 to 60 minutes.

Because your child’s spontaneous speech unfolds during play, the session also works much like a natural language sample. Scores are interpreted alongside everything else the clinician learns, never on their own. If your child speaks more than one language, ask intake which language the session can be conducted in.

Step 3: Vineland-3 adaptive behavior assessment

Adaptive behavior is how your child manages everyday life at home, at school and in the community. The Vineland-3 is a widely used measure of these skills.

What the Vineland-3 measures

The Vineland-3 is often completed as a caregiver interview or rating form, so you describe what your child usually does, not what they might be able to do. Ask how it will be completed for your child.

Skills are rated by how often your child does them on their own, from never to usually. Depending on your child’s age and needs, the Vineland-3 can also include optional areas such as motor skills and maladaptive behavior.

Why adaptive assessment matters

Adaptive measures are often part of a standard autism assessment alongside direct observation. They help show where your child is doing well and where support could help, which can guide recommendations and planning for services such as our early-intervention autism program.

Step 4: Your autism diagnosis and feedback session

After the evaluation steps are complete, a feedback conversation brings the pieces together. A diagnosis is never based on an ADOS-2 score alone; the clinician weighs developmental history, observations and every result as one clinical picture. This matters because autism can be difficult to diagnose given symptom heterogeneity, developmental factors and co-occurring conditions.

Expect an explanation of how observed behaviors do or don’t support the diagnostic conclusion, along with your child’s strengths and areas where support could help. If findings are inconclusive, ask what further information or assessment may help. Whether or not your child receives an autism diagnosis, the recommendations can guide next steps, and findings contribute to a written report you can revisit.

With your written consent, the report can be shared with your child’s pediatrician or school team. Ask intake how long the written report usually takes so you can plan your next steps.

Why a medical diagnosis differs from a school IEP

One of the first questions families ask is whether a diagnosis means an IEP. The answer is no, because these systems serve different purposes:

In Maryland, school eligibility decisions are governed by COMAR 13A.05.01. The school team makes the eligibility decision; if an IEP isn’t offered, a Section 504 plan may help. Your clinical report can inform the school’s review but doesn’t replace the school’s own evaluation.

Documents to share with your school team

Keep copies, and note the date the school receives each document. Under Maryland rules, the initial evaluation must be completed within 60 days of your written consent, and if your child is found eligible, the team must meet to develop the IEP within 30 days.

How your evaluation report connects to ABA therapy

Some treatment authorizations require a documented autism diagnosis, and Maryland Medicaid covers medically necessary ABA for members under 21. A report works best when it documents direct observation, caregiver interview, developmental history and current functioning, rather than a single test score. For military families, TRICARE covers ABA through its Autism Care Demonstration, currently authorized through December 31, 2028, for family members enrolled in a TRICARE plan and diagnosed with autism by an approved provider. Active duty families also enroll in their service branch’s Exceptional Family Member Program (EFMP) and the Extended Care Health Option (ECHO).

If a diagnosis is made, the report can support a referral for ABA. From there, an ABA provider completes their own assessment and writes an individualized treatment plan with measurable goals. The report opens the conversation; your child’s therapy team builds the plan. Ask about BCBA-led ABA planning as part of our autism services.

What Maryland’s autism insurance law covers

Maryland’s autism coverage works through its habilitative services law. Under Maryland Insurance Article §15-835, health plans subject to Maryland law must cover habilitative services for children until the end of the month they turn 19. For children with autism, the Maryland Insurance Administration’s parents’ guide to habilitative services says these services include applied behavior analysis (ABA), behavioral health treatment, psychological care and therapeutic care.

Coverage doesn’t promise that every service or hour will be paid. Ask intake to check your benefits, or see insurance and billing, before you plan around a start date.

How Medicaid and Maryland’s Autism Waiver can help

Maryland’s Autism Waiver is a home and community-based services program for eligible children. Supports it may fund include:

A diagnosis alone doesn’t establish eligibility. Age, level-of-care, financial and other requirements apply, and the Maryland Department of Health lists them in full. Families can ask to join the Autism Waiver Registry, keep their contact information current and keep diagnostic documentation up to date, since waits for the waiver can be long.

Paying for your autism evaluation: insurance and fees

Cost worries shouldn’t keep you from asking questions. Coverage varies by plan and service, so our team confirms benefits before you start and you’ll know what things cost up front. Autism services accept Maryland Medicaid and TRICARE, and the practice works with commercial plans including Aetna, Anthem, Blue Cross Blue Shield/CareFirst, Cigna and UnitedHealthcare.

Even covered evaluations may involve deductibles, copays or coinsurance, and network status affects your balance. Self-funded employer plans sometimes follow different rules, so confirm benefits with your insurer as well. Ask for a written estimate that covers each part of the evaluation, the report and any follow-up visits. Learn more on our insurance and billing page.

Booking your Maryland ADOS-2 evaluation: what to ask

Treat this like any significant health decision: gather details and trust your instincts. You can also ask about adjustments, such as communication preferences, sensory needs or breaks, so the evaluation feels manageable for your child. Before you book, ask:

A good provider welcomes these questions and answers them patiently. Have more questions? Visit our FAQ or request an appointment.

Talk through the next step

Share what you’re noticing and ask about evaluation availability, insurance and which records to bring. You don’t need a diagnosis to contact intake.

If you or your child are in crisis, contact 911, the nearest ER, or call or text 988.